Laserfiche WebLink
JUL-20-1998 14:50 SOUTHLAND MERCHANDISE 503 293 0535 P.03/03 <br />5AN JOAQUnq COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTIi DIVISION <br />(209) 468-3420 <br />,AUTHORIZATION TO RELEA,S <br />SIVE <br />• ANALYTICAL RESULTS <br />c GEOTECHNICAL DATA <br />ENVIRONMENTAL HEALTH <br />PERMITISERVICES <br />m BNVIRONMENTALism ASSESSMENT INFORMATION <br />I, THE UNDEERSIGNED OWNER ANDIOR OPERATOR OF THE PROPERTY ANDIOR FACILM <br />LOCATED AT <br />HEREBY AUT! <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />ilEALTH SERVICES -ENVIRONMENTAL HEALTH DIVIISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR DIY REPRESENTATIVE. <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />land <br />(11 <br />(Mailing Addreu) <br />$' <br />,gignamm) <br />(cry) !a —y (Starr) (Lip Code) <br />PHONE: R t "fG ' ls7 , <br />0014 �fllpw by <br />EH 23 046 (Revised 9111196) <br />Tt? S. T�Wjm IIC5 <br />pvII Cv�671dI�i�- <br />5?D)23�-8/r page <br />-TD �Aq z5g <br />1 q ?59 fiat Gljet,#Ve. <br />,m" <br />I <br />CIA <br />(dry) 33�13� <br />TOTAL P.03 <br />